Fractures In Athletes Research Articles

The Elite Football Players with a Fifth Metatarsal Fracture

Objectives:Fractures of the proximal fifth metatarsal can be a difficult clinical problem, especially in the athlete who wishes to return to competition. Clinical and radiographic evaluation cannot always be relied upon to assess complete healing. Refracture, after operative and nonoperative treatment, of a fifth metatarsal is a known phenomenon. The purpose of the study was to characterize and describe the prevalence of fifth metatarsal fractures in athletes at the NFL Scouting Combine and test the hypothesis that radiographic healing and symptom free return to play in college predict length of career and risk of re-injury.Methods:A retrospective review was performed of the database of players presenting to the annual NFL National Invitational Camp from 2005 to 2010 to identify athletes in whom fifth metatarsal fractures occurred. Each of these players underwent anteroposterior (AP), oblique, and lateral foot radiographs that were analyzed for indicators of hindfoot malalignment in addition to the presence or absence of a residual fracture gap. The date of the injury, the date of surgery (if applicable), and the number of games missed after the injury were also obtained from history. An internet search and NFL.com was used to determine the effect of their prior fifth metatarsal injury on the player’s career (games played, career length, and re-injury).Results:87 feet (81 players; 4.4% of all players) were identified. 52.9% of these injuries occurred in the left foot. Among all NFL Scouting Combine participants, fifth metatarsal fractures most commonly occurred in offensive linemen (20.7%), wide out receivers (20.7%), defensive linemen (17.2%), and defensive backs (11.5%). 78.2% of players were treated with an intramedullary screw. A persistent fracture gap was noted in 18.4% of players. 17.2% of players had a re-injury during their career. No radiographic measurements differed between players that had a residual fracture gap or re-injury. Players that played at least one full collegiate season after injury were less likely to have re-injury during professional play (5.6% vs. 46.7%; p < 0.001) or a residual fracture gap (9.7% vs. 60%; p < 0.001). Players without a residual gap were also less likely to have a re-injury (7% vs. 37.5%; p < 0.001). Players treated with surgery were less likely to have re-injury (10.3% vs. 21.1%) but more likely to have gap formation (20.6% vs. 10.5%).Conclusion:Players who are able to complete at least one full year of collegiate football after a fifth metatarsal fracture are less likely to have re-injury or a residual fracture gap. No radiographic measurements are predictive of re-injury or residual fracture gap.

Foot &amp; ankle

The December 2012 Foot &amp; ankle Roundup360 looks at: correcting the overcorrected club foot; syndesmotic surgery; autograft for osteochondral defects; sesamoidectomy after fracture in athletes; complications in ankle replacement; the arthroscope as a treatment for ankle osteoarthritis; whether da Vinci was a modern foot surgeon; and a popliteal block in ankle fixation.

Medial Malleolar Stress Fracture in Athletes: Diagnosis and Operative Treatment

Stress fractures are common overuse injuries in athletes. Medial malleolar stress fractures are rare but they have an important clinical relevance because of their tendency to cause considerable disability and loss of time in sports without proper treatment. The diagnosis of medial malleolar stress fracture is often a challenge and it is therefore often delayed which may cause even further problems in the treatment. The purpose of this study was to increase the awareness of medial malleolar stress fractures as a possible cause for medial ankle pain and to stress the importance of MRI in the diagnostics as well as to evaluate the results of surgical treatment. Between 1995 and 2008, a total of ten athletes with a medial malleolar stress fracture were operated at our centre. All operated cases during those years were included in the study. The cases were retrospectively analyzed. Return to pre-injury level of sport was evaluated and considered as an indicator of successful treatment. Initially all standard radiographs were negative whereas in MRI the fractures were all visible. After operative treatment all medial malleolar stress fractures healed clinically in three to four months and all except one of the athletes were able to return to their pre-injury level of sports. Early MRI is recommended if a medial malleolar stress fracture is suspected. Surgical treatment seems to result in rapid healing of the fracture and return to sports. In our opinion early surgery should be considered especially in athletes.

Stress fractures of the pelvis and legs in athletes: a review.

Context:Stress fractures are common injuries in athletes, often difficult to diagnose. A stress fracture is a fatigue-induced fracture of bone caused by repeated applications of stress over time.Evidence Acquisition:PubMed articles published from 1974 to January 2012.Results:Intrinsic and extrinsic factors may predict the risk of stress fractures in athletes, including bone health, training, nutrition, and biomechanical factors. Based on their location, stress fractures may be categorized as low- or high-risk, depending on the likelihood of the injury developing into a complete fracture. Treatment for these injuries varies substantially and must account for the risk level of the fractured bone, the stage of fracture development, and the needs of the patient. High-risk fractures include the anterior tibia, lateral femoral neck, patella, medial malleolus, and femoral head. Low-risk fractures include the posteromedial tibia, fibula, medial femoral shaft, and pelvis. Magnetic resonance is the imaging test of choice for diagnosis.Conclusions:These injuries can lead to substantial lost time from participation. Treatment will vary by fracture location, but most stress fractures will heal with rest and modified weightbearing. Some may require more aggressive intervention, such as prolonged nonweightbearing movement or surgery. Contributing factors should also be addressed prior to return to sports.

Headless Compression Screw Fixation of Jones Fractures

Background: Internal fixation is advocated as the primary treatment for fifth metatarsal Jones fractures in athletes; however, screw insertion site discomfort and refracture can occur especially in competitive athletes. The ideal implant has not been determined. Hypothesis: Headless compression screw fixation of proximal fifth metatarsal Jones fractures is an effective treatment approach especially in competitive athletes. Study Design: Case series; Evidence level, 4. Methods: We studied 60 athletes treated surgically with a headless compression screw for fifth metatarsal Jones fractures (mean age, 19 years). The mean follow-up time was 178 weeks. We evaluated the clinical and radiographic outcomes of headless compression screw fixation of Jones fractures. Results: All athletes returned to full activity. The mean time to start running after surgery was 6.3 weeks (range, 3-12.7 weeks), and the mean time to full activity after surgery was 11.2 weeks (range, 6-25 weeks). One athlete suffered a delayed union, which healed uneventfully. One athlete suffered a nonunion and underwent reoperation for a screw exchange to an autogenous bone graft harvested from the iliac crest. No screw breakage was reported. No athlete suffered a refracture or discomfort in the screw insertion site. Conclusion: Headless compression screw fixation of fifth metatarsal Jones fractures provided excellent results, allowing athletes to return to full activity without both screw insertion site irritation and clinical refracture.

Paper 15: Surgical Treatment of Chronic Stress Fractures in Athletes

During 25 years (1982-2007) 170 chronic, painful, risk or nonunion stress fractures in athletes and dancers were treated surgically. The patients represented several sports events, mainly track and field athletics. Endurance athletes, as runners, cross-country skiers, orienteerers and triathlonists were represented with the biggest number of these stress fractures (appr. 65% of all operations). There were 131 stress fracture operations in males (77%) and 39 in females (23%) in the series. The mean age of the patients was 23 years (14-37 years). The number of operations/bones in the material were: anterior mid-tibia 49, tarsal navicular 25, sesamoid bones of the first MTP joint 16, metatarsal bones 15, tarsal bones 14, medial malleolus 12, and patella 7 cases. There were from 1 to 5 stress fracture operations in the following bones/sites: proximal tibia, femoral shaft, femoral neck, pubis, olecranon, humeral shaft, distal fibula, first rib, calcaneal bone, cuboid bone, pisiform bone and hamulus ossis hamati of the wrist. The fracture caused local pain and training/competing was usually not possible. The diagnosis was done by radiographs (100%). It was confirmed by Technetium scan (30%) and MRI (23%). CT examination was used in a few cases. All patients were treated at first conservatively by rest from causative training, non weight- bearing, crutches, casts, local ultrasound, magnetotherapy, osteoporosis medicines, D-vitamin and extra calcium. Delayed or non-union developed in 125 cases (76%). The risk for a complete fracture was estimated in 21 cases (12.5%) and in the rest of the cases, persistent pain and non healing was indication for surgery. A complete fracture had occurred 14 times, during training or competition. Different surgical techniques were used in the treatment. High risk stress fractures, as femoral neck, distal femoral shaft, mid-tibia, patella, tarsal navicular and MT V basis were treated with internal fixation (nail, screws, plates or tension band method). Pseudoarthrosis surgery included sometims curettage and bone grafting. Some stress fractures were treated with drilling of the fracture site. Postoperative treatment consisted of short immobilization, non weight-bearing and rest, followed by early isometric exercises, swimming, water training, bicycling, weight training and gym trainig. The patients were followed clinically and by radiographs as long as the healing had occurred and the end result was clear. The training pause depended on the bone and surgical treatment method. The patients were able to return to there sports 2-12 months after surgery. The patients were followed appr. for 2 years. The result from surgery was good or excellent in 86 per cent of the cases. All these athletes were able to come back to the same level as before. There were some complications and recurrences in the series. A reoperation was needed in 9 cases. Removal of the osteosynthesis material was done in 91 cases.

Lower extremity and pelvic stress fractures in athletes

Stress fractures occur following excessive use and are commonly seen in athletes, in whom the lower limbs are frequently involved. Delayed diagnosis and management of these injuries can result in significant long-term damage and athlete morbidity. A high index of suspicion may facilitate diagnosis, but clinical presentation may be non-specific. In this regard, imaging in the form of plain radiograph, CT, MRI and bone scintigraphy may be of value. This article reviews the incidence, presentation, radiological findings and management options for athletes with stress fractures of the lower limb.

Metacarpal and phalangeal fractures in athletes

Spor yaralanmalari sonucu olusan metakarp ve falanks kiriklari sik gorulen ve sporcunun kariyerini etkileyebilen yaralanmalardir. Amator, profesyonel sporcular ya da spor ile ugrasmayan insanlarda tedavi secenekleri arasinda hicbir fark yoktur. Sporcularda tedavi yaklasimindaki farklilik endikasyonlardan, ameliyat sonrasi tespitin suresi ve bakim ile spora donusun zamanlamasindan kaynaklanmaktadir. Sporcularda bu kiriklarin tedavisinde asil hedef, sporcuyu olabildigince erken sporla ilgili faaliyetlere dondurmek ve tekrarlama riskini en aza indirmektir. El kiriklarinin tedavisi sirasinda yapilan spor sekli, oyuncunun oyundaki yeri, seviyesi ve elini kullanma gereksinimi goz onune alinmalidir. Cerrah; tedavi seceneklerini, olasi riskleri ve faydalari sporcunun kendisine, hocasina ve yoneticilere acikca anlatmali ve hicbir zaman uzun donemli sonuclari, kisa vadeli beklentilere feda etmemelidir.

Scaphoid fractures in athletes

Skafoid kiriklari, el bilegi icin malunionun baslica nedenlerinden biri olabilir. Bu kiriklar, gundelik yasam aktivitelerinin yani sira, sportif faaliyetler sirasinda da sikca olusabilir. Bu tur kiriklarin insidansi boksorler, futbolcular ve jimnastikciler ve diger musabaka sporcularinda daha yuksektir. Kirilan skafoid, fleksiyon egilimi icindedir. Skafoid kiriklarina bagli dorsal interkalar segment instabilitesi veya skafoid kaynamama ilerleyici cokmesi de gelisebilir. Bu nedenle, kirik tipi ve yerlesimine ozgu iyi bir tedavi plani uygulanmalidir. Skafoid kiriklarin yerlesimi agirlikli olarak (%80) bel ve tuberkul bolgesindedir. Bu bolgedeki yer degistirmemis kiriklarda kaynama orani %90 civarinda olmakla birlikte, kaynamama durumunda tedavi basarisizligi %25-45 arasindadir. Kirik suphesi olan sporculara manyetik resonans goruntulemenin hemen yapilmasi onerilir. Son yillarda kapali kanullu vida uygulamalari ile basarili sonuclar literaturde yer almaktadir. Bununla birlikte, hangi tedavi secilirse secilsin hastanin duzenli araliklarla takip edilmesi buyuk onem tasimaktadir.

Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series

BackgroundDelayed unions or refractures are not rare following surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fractures. Intramedullary screw fixation with bone autografting has the potential to resolve the issue. The purpose of this study was to evaluate the result of the procedure.MethodsThe authors retrospectively reviewed 15 athletes who underwent surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fracture. Surgery involved intramedullary cannulated cancellous screw fixation after curettage of the fracture site, followed by bone autografting. Postoperatively, patients remain non weight-bearing in a splint or cast for two weeks and without immobilization for an additional two weeks. Full weight-bearing was allowed six weeks postoperatively. Running was permitted after radiographic bone union, and return-to-play was approved after gradually increasing the intensity.ResultsAll patients returned to their previous level of athletic competition. Mean times to bone union, initiation of running, and return-to-play were 8.4, 8.8, and 12.1 weeks, respectively. Although no delayed unions or refractures was observed, distal diaphyseal stress fractures at the distal tip of the screw occurred in two patients and a thermal necrosis of skin occurred in one patient.ConclusionsThere were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing. These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

Foot &amp; Ankle

The April 2012 Foot &amp; Ankle Roundup360 looks at injecting the tendon sheath, total ankle replacement, heterotopic ossification, replacement or arthrodesis, achilles tendinopathy, healing of the torn Achilles, grafting of the calcaneal bone cyst, avulsion fractures in athletes, percutaneous distal osteotomy for bunionette formation, and repairing the torn tibiofibular syndesmosis

Isolated Hyoid Bone Fractures in Collegiate Football Players

Hyoid fractures in athletes are rare injuries that can be difficult to diagnose. Typically resulting from a direct blow to the anterior neck, hyoid fractures can lead to subcutaneous edema and subsequent airway compromise. The treatment of this fracture depends largely on the severity of the presenting symptoms. Generally, these fractures do not require surgical intervention but warrant close observation for delayed onset of airway obstruction. To raise awareness of this potentially dangerous fracture, the authors present 2 cases of isolated hyoid fractures in collegiate football players at our institution.

Surgical Treatment of Diaphyseal Stress Fractures of the Fifth Metatarsal in Competitive Athletes

Proximal diaphyseal stress fractures of the fifth metatarsal are common in athletes. Conservative treatment has been shown to result in high rates of delayed union, nonunion, and refracture, so internal fixation has become the treatment of choice in competitive athletes. Twenty top-level athletes with diaphyseal stress fractures fixed with intramedullary malleolar screws were evaluated. Functional outcome was assessed by American Orthopaedic Foot and Ankle Society midfoot score. Static and dynamic maximum vertical force and peak plantar pressures were evaluated with a computerized pedobarograph. Mean follow-up from surgery to interview was 10.3 years (range, 3.5-19.0 years). Clinical healing was 95%, and there has been one refracture (5%). The mean time from surgery to return to sport was 9 weeks (range, 5-14 weeks). Twelve athletes (60%) returned to a higher level of training, 7 (35%) to the same level, and 1 (5%) to a lower level compared with the level of training before injury. Average American Orthopaedic Foot and Ankle Society midfoot score was 93.8 (range, 85-100). During the computerized pedobarographic evaluations, 18 patients (90%) presented with varus of the metatarsus and the midfoot and 2 (10%) presented with a normal plantigrade foot. Intramedullary malleolar screws can yield reliable and effective healing of fifth metatarsal stress fractures in athletes. Varus of the metatarsus and the midfoot were predisposing factors for stress fractures in this population of competitive athletes, and all were recommended to wear orthoses until their competitive careers were completed.

Blinded-Read of Bone Scintigraphy

This study evaluated the use of bone scintigraphy (BS) for the diagnosis of stress fractures in athletes and its validity for the prediction of healing time, with a focus on foot injuries. In our retrospective study, 84 athletes with a total of 93 suspected stress fractures (foot, n = 66; others, n = 27) were included. A blinded-read of BS was performed by 3 observers. The standard of reference was established by an interdisciplinary truth-panel using all imaging data (scintigraphic, radiographic, and magnetic resonance imaging) and follow-up data (>12 month). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosing stress fractures were calculated. Stress injuries were rated according to a 5-point grading score (0-4) and associated to the healing time. For the diagnosis of stress injuries (n = 50/93), mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 97.3%, 67.4%, 77.7%, 95.6%, and 83.5%, respectively. Interobserver analysis showed a high agreement between all 3 readers (mean κ = 0.83). In univariate analysis healing time of grade 3 to 4 stress injuries was significantly higher (median, 87 days; interquartile range, 69-132 days) compared with grade 1 to 2 lesions (median, 63 days; interquartile range, 43-95 days; P = 0.0067). Moreover, healing time of scintigraphic high grade stress injuries was significantly longer in a general linear model with adjustment for cofactors (grade, 3-4 vs. 1-2; P = 0.033). BS is a sensitive and reliable method for the diagnosis of stress injuries. In addition, the simplified classification for mild and severe stress injuries allows an estimation of healing time.

Percutaneous Internal Fixation of Proximal Fifth Metatarsal Jones Fractures (Zones II and III) With Charlotte Carolina Screw and Bone Marrow Aspirate Concentrate

Background: Internal fixation is a popular first-line treatment method for proximal fifth metatarsal Jones fractures in athletes; however, nonunions and screw breakage can occur, in part because of nonspecific fixation hardware and poor blood supply. Purpose: To report the results from 26 patients who underwent percutaneous internal fixation with a specialized screw system of a proximal fifth metatarsal Jones fracture (zones II and III) and bone marrow aspirate concentrate. Study Design: Case series; Level of evidence, 4. Methods: Percutaneous internal fixation for a proximal fifth metatarsal Jones fracture (zones II and III) was performed on 26 athletic patients (mean age, 27.47 years; range, 18-47). All patients were competing at some level of sport and were assessed preoperatively and postoperatively using the Foot and Ankle Outcome Score and SF-12 outcome scores. The mean follow-up time was 20.62 months (range, 12-28). Of the 26 fractures, 17 were traditional zone II Jones fractures, and the remaining 9 were zone III proximal diaphyseal fractures. Results: The mean Foot and Ankle Outcome Score significantly increased, from 51.15 points preoperatively (range, 14-69) to 90.91 at final follow-up (range, 71-100; P < .01). The mean physical component of the SF-12 score significantly improved, from 25.69 points preoperatively (range, 6-39) to 54.62 at final follow-up (range, 32-62; P < .01). The mean mental component of the SF-12 score also significantly improved, from 28.20 points preoperatively (range, 14-45) to 58.41 at final follow-up (range, 36-67; P < .01). The mean time to fracture healing on standard radiographs was 5 weeks after surgery (range, 4-24). Two patients did not return to their previous levels of sporting activity. One patient experienced a delayed union, and 1 healed but later refractured. Conclusion: Percutaneous internal fixation of proximal fifth metatarsal Jones fractures, with a Charlotte Carolina screw and bone marrow aspirate concentrate, provides more predictable results while permitting athletes a return to sport at their previous levels of competition, with few complications.

Percutaneous Cannulated Screw Fixation of Fifth Proximal Metatarsal Stress Fracture in Athletes

The purpose of this study was to know utility of percutaneous cannulated screw fixation of fifth proximal metatarsal stress fractures in athletes by assessment of radiological and clinical outcome. This study examined clinical and radiological union time of eleven cases of percutaneous screw fixation, which used the 4.0 mm cannulated screw, of fifth proximal metatarsal stress fracture in athletes. Type I of Torg classification is 7 cases, type II is 3 cases and type III is 1 case. All the cases showed fracture union, and all the patients resumed their athletics at the final follow-up. None of the cases complained of refracture or pain around where they had surgery, and visual analogue scale of pain, and American Orthopedic Foot and Ankle Society score was 0.73 and 93.4. The results of the study confirm that percutaneous screw fixation, which used the cannulated screw, of fifth proximal metatarsal stress fracture would help athletes resume their athletics in early stages.

Surgical Excision of Symptomatic Nonunion of Fifth Metatarsal Base Avulsion Fracture in Athletes

The purpose of this study was to evaluate the clinical results of surgical excision of symptomatic nonunion of fifth metatarsal base avulsion fracture in athletes. From February 2008 to December 2009, six athletic patients who had a symptomatic nonunion of fifth metatarsal base avulsion fracture underwent surgical excision of ununited bony fragment and they were followed for more than 12 months. The mean age was 18.5 years and the mean follow-up period was 13 months. The clinical results were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scoring system and Visual Analogue Scale (VAS) scoring system and statistically analyzed (SPSS ver. 18.0). The AOFAS and VAS score was improved in all patients. The mean AOFAS forefoot score was improved from 58.6±5.7 preoperatively to 95±5.4 postoperatively, which indicated significant difference (p=0.024). The mean preoperative VAS score was 8.0±0.6 and the mean postoperative VAS score was 1.6±0.5 cm, which indicated significant difference (p=0.023). There were no postoperative problems and functional loss on the operation lesions. The surgical excision of symptomatic nonunion of fifth metatarsal base avulsion fracture in athletes was found to be one of the ideal treatment option for early return to full activity and relief of pain.

Analysis of stress fractures in athletes based on our clinical experience

To analyze stress fractures in athletes based on experience from our sports medicine clinic. We investigated the association between stress fractures and age, sex, sports level, sports activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and April 2009. Stress fractures of the pars interarticularis were excluded from this analysis. During this period (18 years and 8 mo), 14276 patients (9215 males and 5061 females) consulted our clinic because of sports-related injuries, and 263 patients (1.8%) [171 males (1.9%) and 92 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.2 years (range 10-46 years); 112 patients (42.6%) were 15-19 years of age and 90 (34.2%) were 20-24 years of age. Altogether, 90 patients (34.2%) were active at a high recreational level and 173 (65.8%) at a competitive level. The highest proportion of stress fractures was seen in basketball athletes (21.3%), followed by baseball (13.7%), track and field (11.4%), rowing (9.5%), soccer (8.4%), aerobics (5.3%), and classical ballet (4.9%). The most common sites of stress fractures in these patients were the tibia (44.1%), followed by the rib (14.1%), metatarsal bone (12.9%), ulnar olecranon (8.7%) and pelvis (8.4%). The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site in baseball players, and the rib was the most common in rowers. Basketball and classical ballet athletes predominantly sustained stress fractures of the tibia and metatarsal bone. Track and field and soccer athletes predominantly sustained stress fractures of the tibia and pubic bone. Aerobics athletes predominantly sustained stress fractures of the tibia. Middle and long distance female runners who sustained multiple stress fractures had the female athlete triad. The results of this analysis showed that stress fractures were seen in high-level young athletes, with similar proportions for males and females, and that particular sports were associated with specific sites for stress fractures. Middle and long distance female runners who suffered from multiple stress fractures had the female athlete triad.

Stress Fractures of the Metacarpal Bones in Adolescent Tennis Players

Background: There are 12 reported cases of metacarpal stress fractures in athletes, with only 4 of them involving the second metacarpal. Purpose: The authors describe stress fracture of the second metacarpal bone in teenaged tennis players and the relationship with sport intensity and type of grip used. They also demonstrate that magnetic resonance imaging is the diagnostic study of choice to differentiate this entity from the most common cause of pain in this region of the hand in tennis players—the carpal boss. Study Design: Case series; Level of evidence, 4. Methods: Seven adolescent tennis players (mean age, 16.5 years; 6 female, 1 male) with dorsal hand pain produced by playing tennis were examined by radiographs and initial magnetic resonance imaging. In 2 cases, bone scintigraphy was performed. In the first 2 cases, the presumptive diagnosis was a carpal boss, but with this experience, the diagnostic evaluation of the last 5 cases was oriented toward a stress reaction at this level. Radiologic follow-up was performed. The authors also evaluated the grip type used by each tennis player. Results: Clinical evaluation and imaging studies resulted in a diagnosis of stress injury of the second metatarsal in 6 of 7 cases, with the seventh case involving the third metacarpal. Initial imaging was positive in 3 cases, revealing an increased signal in the marrow without hairline crack and cortical thickening of the shaft or simply an increased signal in the marrow. In all cases, there was a history of recent increase in the sport training load. Six of the 7 tennis players were using a semi-Western or Western grip. Conclusion: Stress fractures of the second metacarpal are characteristic of adolescent tennis players and are associated with an increased intensity of tennis play and may be associated with use of the semi-Western or Western grip. Magnetic resonance imaging is the most useful tool for obtaining a definitive diagnosis.

Does Shoe Insole Modification Prevent Stress Fractures? A Systematic Review

Stress fractures can be debilitating in athletes and military personnel. Insoles may lower stress fracture rates by improving biomechanics, lessening fatigue, and attenuating impact. The objective of this study was to systematically review the best evidence on the use of insoles as a method of stress fracture prevention in a high-risk population. Using MEDLINE, Cochrane, Current Controlled Trials, UK National Research Register, ScienceDirect, CINAHL, and EMBASE, a review of randomized (level I) and quasi-randomized (level II) controlled trials was performed using an insole as the intervention and stress fracture incidence as the primary outcome measure. Five trials were included, and a random effects model was used to generate a summary estimate and an overall odds ratio. One study found a significant reduction in overall stress fracture incidence using a semirigid insole, while four studies found no overall reduction in military personnel. However, when the data are pooled, orthotic use was beneficial. When stratified by site, there was a reduction in femoral and tibial stress fracture incidence. Shoe insoles may reduce the overall femoral and tibial stress fracture incidence during military training. It is unclear if the use of insoles would prevent stress fractures in athletes. Additional studies are necessary to determine the efficacy of insoles in an athletic population.